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Review
. 2024 Feb 9:22:100278.
doi: 10.1016/j.wnsx.2024.100278. eCollection 2024 Apr.

Acute back pain: Clinical and radiologic diagnosis: WFNS spine committee recommendations

Artem O Gushcha  1 , Salman Sharif  2 , Mehmet Zileli  3 , Joachim Oertel  4 , Corinna C Zygourakis  5 , Adilya R Yusupova  1
Affiliations
Review

Acute back pain: Clinical and radiologic diagnosis: WFNS spine committee recommendations

Artem O Gushcha et al. World Neurosurg X. .

Abstract

Objective: To formulate the most current, evidence-based recommendations for the clinical and radiologic diagnosis of acute low back pain lasting <4 weeks.

Methods: A systematic literature search in PubMed and Google Scholar databases was performed from 2012 to 2022 using the search terms "acute back pain AND clinical diagnosis" and "acute back pain AND radiologic diagnosis". Screening criteria resulted in a total of 97 papers analyzed. Using the Delphi method and two rounds of voting, the WFNS (World Federation of Neurosurgical Societies) Spine Committee generated ten final consensus statements.

Results: Ten final consensus statements address the clinical diagnosis of acute LBP, including which clinical conditions cause acute LBP and how we can distinguish between the different causes of LBP, including discogenic, facet joint, sacroiliac joint, and myofascial pain. The most important step for the radiologic diagnosis of acute LBP is to evaluate the necessity of radiologic investigation, as well as its timing and the most appropriate type of imaging modality. Importantly, imaging should not be a routine diagnostic tool, unless red flag signs are present. In fact, routine imaging for acute LBP can actually have a negative effect as it may reveal incidental radiographic findings that exacerbate patient fear and anxiety.

Conclusion: Overall, the quality of evidence is not high for most of our consensus statements, and further studies are needed to validate the WFNS Spine Committee recommendations on the clinical and radiographic diagnosis of acute LBP.

Keywords: Discogenic pain; Facet joint pain; Imaging in acute back pain; Myofascial pain; Red flag signs; Sacroiliac joint pain.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Prisma chart for the review.
Fig. 2
Fig. 2
Overview of red flags in back pain.
See this image and copyright information in PMC

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